NPI | 1053458125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00086) |
Additional Taxonomies | 208600000X Surgery (Licence: TX SA00086) |
Enumeration Date | 2007-01-30 |
Last Update Date | 2022-07-08 |